An article in the New England Journal of Medicine (Volume 394, Number 6, Pages 622-623, February 5, 2026) compares cold perfusion and static cooling of kidneys from deceased donors. Static cooling reduces metabolism to 5% of normal, but in an anoxic environment leads to ATP depletion and succinate accumulation, causing ischemia-reperfusion injury and delayed graft function (DGF).[1] Cold perfusion, such as hypothermic machine perfusion (HMP) or oxygenated HMP (HMPO2), is safe and reduces complications after transplantation in kidneys from circulatory death donors.[4] In the COMPARE trial, there was no significant difference in eGFR at 12 months (50.5 mL/min/1.73 m² in HMPO2 vs. 46.7 mL/min/1.73 m² in HMP, difference 3.7; p=0.12).[4] Normothermic perfusion (NMP) after static cooling did not reduce DGF in DCD kidneys, but is feasible and safe.[1] Solutions such as HTK and IGL-1 for static cooling reduce the risk of DGF versus EC (OR 0.735–0.926 for HTK).[5] The article follows on from long-term data after 10 years from a similar study.[6]